Why does hormonal acne happen?

How do hormones turn into pimples?

Androgens stimulate oil glands. During puberty, these glands enlarge and produce more oil. Oil and dead skin cells can block hair follicles, the small channels where hair grows. Bacteria in blocked follicles contribute to inflammation and pus. The result can range from blackheads and whiteheads to inflamed pimples and deep, painful lumps.134

Oil is only part of the process. Oil gland cells also produce substances that promote inflammation, and a blocked follicle can rupture and trigger more inflammation. Genetics and differences in the immune response help explain why similar hormonal changes produce more severe acne in some people than others.5

Why does it flare at certain times?

• Periods: Changes in hormone activity can bring recurring breakouts around your period.
• Pregnancy: Hormonal fluctuations can trigger acne. Breakouts sometimes improve as pregnancy progresses or continue after delivery.
• Menopause: Falling estrogen and increasing androgens can stimulate oil production.
• Stopping birth control: Coming off contraception containing estrogen can bring back acne that the medication was suppressing.
• Testosterone treatment: Testosterone, including anabolic steroids, can increase oil production and trigger acne.

Hormones influence teenage acne too; "hormonal acne" commonly refers to breakouts in adulthood. Adult acne can continue from adolescence, return after years without breakouts or start for the first time. It affects men and women, although adult acne is more common in women.13

Does acne mean your hormones are abnormal?

Not necessarily. Sensitivity to androgen hormones can contribute to acne, so breakouts alone are not a reason to assume a hormonal disorder. Most acne does not need laboratory testing. A clinician can consider hormone tests when other features are unusual. Polycystic ovary syndrome can provoke acne; mention irregular periods or excessive hair growth when discussing breakouts.67

What else can make breakouts worse?

Stress can worsen existing acne rather than cause acne by itself. Too little sleep, oily cosmetics and some medicines can also contribute. Oily hair products can contribute to blocked follicles, even if their assigned job was technically hair. Tell your clinician about medicines you take or recently stopped, including steroids.36

Some studies link acne with dairy and foods that raise blood sugar quickly. Diet's role is difficult to study, and changing what you eat does not reliably clear acne. Hormones, inherited susceptibility, blocked follicles and inflammation remain relevant even when diet contributes.5

What can you do about it?

Wash with a gentle cleanser twice daily and remove makeup at the end of the day. Avoid scrubbing, picking and squeezing, which can worsen irritation or cause scars.4

Treatment can target blocked pores, bacteria and inflammation, not just hormones. Options include benzoyl peroxide, azelaic acid and topical retinoids, medicines related to vitamin A. A clinician can consider certain combined birth control pills or spironolactone for hormone driven acne. Improvement often takes four to six weeks, while retinoids can take several months.1267

When should you get medical help?

See a clinician for sudden severe adult acne, deep painful lumps, scarring, worsening breakouts or acne that is not improving with treatment. Get help if acne affects your mental health. If you are pregnant or planning pregnancy, discuss treatment before using acne medicines; topical retinoids and isotretinoin should be avoided during pregnancy.124